Provider Demographics
NPI:1194289710
Name:GRIEGO, ERNEST
Entity type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:
Last Name:GRIEGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 S MAGIC WAY SPC 130
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-8636
Mailing Address - Country:US
Mailing Address - Phone:719-271-3565
Mailing Address - Fax:
Practice Address - Street 1:2050 S MAGIC WAY SPC 130
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89002-8636
Practice Address - Country:US
Practice Address - Phone:719-271-3565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health